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Technical Manual
Caution: Federal law (USA) restricts this device to sale by or on the order of a
physician.
The following list includes trademarks or registered trademarks of Medtronic in the
United States and possibly in other countries. All other trademarks are the property
of their respective owners.
Medtronic
Medtronic 5392
Contents
1 Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
1.1 About this manual . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
1.2 Symbols . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
1.3 General description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
1.4 Intended use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
1.5 Package contents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
1.6 Compatible accessory components . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
1.7 Contraindications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
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7 Specifications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81
7.1 Device specifications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81
7.2 Pacing information tables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85
8 Special notice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88
8.1 Special notice for the temporary pacemaker . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88
9 Troubleshooting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89
9.1 Troubleshooting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99
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1 Overview
1.2 Symbols
Explanation of symbols
System meets the applicable Canadian and U.S. electrical safety
standards.
Caution
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Explanation of symbols
Defibrillation-proof type CF applied part
Package contents
Product documentation
Accessories
Humidity limitation
Battery
Reorder number
Manufacturer/Date of manufacture
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Explanation of symbols
Date of manufacture
Serial number
This product conforms to IP21. There are no openings that allow the
user to insert a finger or similarly sized objects. The product is
resistant to dripping water or vertically falling drops.
China RoHS
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Note: The temporary pacemaker is a constant current device. When it emits a pulse, the
current output is maintained at a constant value. This value is set by the output control and
does not vary.
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1.7 Contraindications
There are no known contraindications for the use of temporary pacing as a means to control
heart rate. However, the patient’s age and medical condition may dictate the type of
temporary pacemaker and lead system that the physician uses.
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2.1 Warnings
Patient monitoring – Monitor the patient continuously while the temporary pacemaker is in
use to ensure it is operating properly and delivering appropriate therapy to the patient.
Equipment modification – Do not modify the temporary pacemaker. Modifications could
impact the temporary pacemaker effectiveness and adversely affect patient safety.
Temporary pacemaker compatibility – Only connect items that have been specified as
part of the temporary pacemaker or that have been specified as being compatible with the
temporary pacemaker.
Temporary pacemaker use – The temporary pacemaker is not suitable for use in the
presence of a flammable anesthetic mixture with air or with oxygen or nitrous oxide.
Defibrillation/cardioversion – The temporary pacemaker is protected from damage
caused by internal defibrillation discharges up to 50 J (watt-seconds) and external
defibrillation discharges up to 360 J. However, it is recommended that paddles be placed as
far away from the temporary pacemaker or the lead system as is practical.
Whenever possible, for the safety of the patient, disconnect the temporary pacemaker from
the implanted lead system before defibrillating or cardioverting. Excessive defibrillation
energy can damage the temporary pacemaker. This can result in a large current flowing
through the implanted lead system and temporary pacemaker, which could reduce intended
defibrillation energy delivered to the patient or cause myocardial damage.
If damage to the temporary pacemaker is suspected due to defibrillation, disconnect it from
the patient and return it to Medtronic for service.
Line-powered equipment – An implanted lead or a lead with an extension cable
constitutes a direct, low-resistance current pathway to the myocardium. Due to the danger
of tachyarrhythmias resulting from alternating current leakage, extreme caution must be
taken to properly ground all line-powered equipment used on or in the vicinity of the patient.
Electrosurgical units (cautery) – Electrosurgical units can cause loss of pacing from
oversensing or tachyarrhythmias by inducing current on the leads, and thus should never be
used within 15 cm (6 in) of the pacemaker/lead system.
Ablation (RF ablation or microwave ablation) – Ablation is a surgical technique in which
radio frequency (RF) or microwave energy is used to destroy cells by creating heat. Ablation
used in cardiac device patients may result in, but is not limited to, induced ventricular
tachyarrhythmias, oversensing, unintended tissue damage, device damage, or device
malfunction.
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Pulse-modulated ablation systems may pose higher risk for induced ventricular
tachyarrhythmias. Medtronic cardiac devices are designed to withstand exposure to
ablation energy. To mitigate risks, observe the following precautions:
● Ensure that temporary pacing and defibrillation equipment is available.
● Avoid direct contact between the ablation catheter and the temporary leads.
● Position the return electrode patch so that the electrical current pathway does not pass
through or near the device and leads.
● Continuously monitor the patient during ablation with at least two separate methods,
such as arterial pressure display, ECG, manual monitoring of the patient’s rhythm
(taking pulse) or monitor by some other means such as ear or finger pulse oximetry, or
Doppler pulse detection.
To avoid or mitigate the effects of oversensing, if appropriate for the patient, initiate
asynchronous pacing.
Electromagnetic interference (EMI) – Pacemakers operating in the demand mode
respond to intracardiac potentials with magnitudes of a few mV. This level of sensitivity
makes the temporary pacemaker inherently sensitive to some external fields. In the
presence of excessive levels of interference, the temporary pacemaker may inhibit
completely or revert to asynchronous operation, pacing at the rate set by the RATE dial.
It is recommended that the temporary pacemaker be set to an asynchronous pacing mode
at a rate higher than the patient’s intrinsic rate when operated in the presence of strong
electromagnetic interference (EMI).
Sources of excessively strong EMI that may temporarily affect the operation of the
temporary pacemaker include the following:
● Electrosurgical equipment
● Diathermy equipment
● Some medical telemetry equipment (when operated within 1 m [about 3 feet] of the
pacemaker)
● Communication transmitters such as cellular phones, “walkie talkies”, and transmitters
in emergency transport vehicles
● Magnetic resonance imaging (MRI) equipment
Atrial High-Rate Burst Pacing Therapy (Rapid Atrial Pacing) – Use of high rates in the
atrium could result in high-rate conduction to the ventricle. Defibrillation equipment should
be on standby, immediately available during atrial high-rate burst pacing therapy.
There is no ventricular back-up pacing during delivery of atrial high-rate burst pacing
therapy.
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Connecting the lead system – The patient cables should be connected to the temporary
pacemaker before the lead(s) is connected to the patient cable(s).
Handling implanted leads – When handling implanted leads (temporary or permanent),
the terminal pins or exposed metal must not be touched nor be allowed to contact electrically
conductive or wet surfaces.
MR unsafe – The temporary pacemaker is MR unsafe. Do not bring the temporary
pacemaker into Zone 4 (magnet room), as defined by the American College of Radiology.
2.2 Precautions
Random failures – The physician should be aware that operational failure of the temporary
pacemaker can occur as the result of battery depletion, mishandling, or random component
failure.
Possible operational failures of the temporary pacemaker can include the following:
● No output or erratic output
● No sensing or erratic sensing
● False indicator light signals
● Inappropriate variance of rate, output pulse width, or output amplitude
● Reversion to asynchronous pacing
● Loss of control of rate, output, sensitivity, or power
If loss of control of rate, output, sensitivity, or power occurs, and it is not due to a low battery,
disconnect the temporary pacemaker from the patient and return it to Medtronic for service.
Temporary pacemaker repair – Do not attempt to repair the temporary pacemaker. Only
a qualified Medtronic Technical Services representative can repair the temporary
pacemaker. Contact Medtronic at the telephone number on the back cover of this manual if
the temporary pacemaker requires service.
Service condition – Before each use, evaluate the temporary pacemaker for damage and
observable defects. Do not use the temporary pacemaker if the case is cracked, the controls
are not functioning, the displays are not working, or if the controls, displays, or connectors
are broken. If the temporary pacemaker has any observable defects, contact Medtronic at
the telephone number on the back cover of this manual for service.
Cleaning, disinfection, and sterilization – Clean and disinfect the temporary pacemaker
before each use for a new patient. Clean and sterilize the reusable cables before each use
for a new patient.
Batteries – Only install the recommended batteries in the temporary pacemaker. Batteries
with different physical dimensions, non-alkaline (e.g., lithium or rechargeable) or batteries
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with contamination on the battery terminals, may result in erratic operation of the temporary
pacemaker, no pacing output, or damage to the temporary pacemaker, specifically to the
battery compartment.
Replace the batteries for each new patient and when the low battery indicator flashes during
temporary pacemaker operation.
Only use new, fresh batteries that have not passed their expiration date.
Inspect battery terminals for contamination. Using batteries with contaminated terminals
can result in the temporary pacemaker turning off, decreased battery life, or corrosion to the
battery compartment.
Check the battery status at least twice daily. Replace alkaline batteries at least once every
week when the temporary pacemaker is in continuous use or when the low battery indicator
flashes. Verify that the battery drawer is fully closed and latched in place.
Failure to ensure that the battery drawer is fully latched may result in loss of power.
Continued temporary pacemaker operation is not an indication that the battery drawer is
properly latched.
Battery installation – Ensure that the new, fresh batteries are installed with the correct
battery polarity by verifying that the batteries align with the polarity markings on the inside of
the battery drawer. The temporary pacemaker requires proper battery polarity for operation.
After installing the batteries, ensure that the battery status indicator displays full battery
power and that the low battery indicator is not flashing. The temporary pacemaker may
temporarily continue to pace and sense with weak, dead, or incorrectly installed batteries.
Pacing leads and cables – Improper connection, displacement, or fracture of leads or
cables may result in pacemaker system failure. Inspect leads and cables for damage before
each use.
Pacing system adjustments – Monitor the patient’s ECG and blood pressure. Keep
defibrillation equipment on standby, immediately available for emergency use during
evaluation of stimulation and sensing thresholds, pacemaker and pacing lead connections
and adjustments, and atrial high-rate burst pacing therapy.
Default DDD pacing mode – The default power-up settings for the DDD pacing mode are
not always appropriate for every patient or situation. Select the appropriate pacing mode to
meet the pacing needs of the patient.
Patient monitoring after defibrillation – Monitor the patient after a defibrillation has
occurred to verify that the temporary pacemaker and the cable/lead systems are still
delivering the appropriate therapy.
Bipolar lead systems – Bipolar lead systems are recommended because they are less
susceptible to electromagnetic interference. Separation between the positive (+) electrode
and negative (–) electrode of the same lead system should not exceed 15 mm (0.6 in). Place
the atrial and ventricular lead systems at right angles to each other. Verify that the electrodes
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of one system are a minimum of 4 cm (1.5 in) from the electrodes of the other system. Failure
to follow these spacing recommendations could result in oversensing. Clinical risks for not
following these spacing recommendations include, but are not limited to, loss of pacing
output, asynchronous ventricular pacing, and pacemaker mediated tachycardia.
Unipolar lead systems – Unipolar lead systems are not recommended because they are
more susceptible to electromagnetic interference, which may result in inappropriate pacing.
Unipolar lead systems should not be used in the dual-chambered pacing modes because
the current path of one lead system may interfere with the current path of the other.
Dual chamber pacing modes – Do not configure the temporary pacemaker in any of the
dual chamber pacing modes unless both channels are connected to the heart. If the
temporary pacemaker is configured in a dual chamber pacing mode and one of the channels
is not connected, the open channel could pick up unintended noise. The noise can be
interpreted as a sensed event and can lead to events such as, but not limited to,
asynchronous ventricular pacing, unintended pacing inhibition, or ventricular tachycardia.
Avoid use of dual chamber pacing modes without an atrial connection as this could, in rare
circumstances, result in inappropriate delivery of a ventricular pace on an intrinsic T-wave.
Atrial sensing – When programming to a mode that requires atrial sensing, the sensing
threshold should be evaluated for sufficient safety margin.
Place the temporary pacing lead on the right atrial free wall, oriented along the direction of
the myocardial fibers, approximately 1 cm (0.4 in) apart. It is important to achieve a sensing
threshold of at least 1.0 mV. Set atrial sensitivity to a minimum of one-half the measured
threshold. The setting ensures a minimum safety margin of two times the sensing threshold.
Failure to follow this procedure can lead to delivery of asynchronous pulses.
Sensing thresholds – Do not use the temporary pacemaker to determine sensing
thresholds for permanently implanted lead systems. When implanting a permanent
pacemaker, Medtronic recommends the use of a pacing system analyzer (PSA).
Sensitivity settings – Since the sensitivity setting determines the smallest signal that can
be sensed by the pacemaker, set the sensitivity dial to one-half the mV value of the patient’s
sensitivity threshold. This setting will provide a 2x safety margin to ensure proper sensing.
A more sensitive setting may be chosen to provide a greater safety margin. However, be
aware that setting the sensitivity value too low (too sensitive) could result in inappropriate
sensing of far field signals (for example, sensing of R-waves or T-waves on the atrial channel
or P-waves on the ventricular channel), leading to inappropriate inhibition of pacing pulses.
Sensitivity threshold testing – Complete the sensitivity threshold testing to determine the
appropriate settings for sensitivity. Clinical risks for failure to perform this step include, but
are not limited to, asynchronous ventricular pacing and pacemaker mediated tachycardia.
Output threshold testing – Complete the output threshold testing to determine the
appropriate settings for output. Clinical risks for failure to perform this step include, but are
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not limited to, loss of capture, retrograde conduction, induced tachycardia, and loss of
hemodynamic support.
High output and maximum sensitivity – Although the temporary pacemaker contains a
safety pacing feature that prevents inappropriate inhibition of ventricular pacing due to
far-field sensing, the simultaneous use of high output and maximum sensitivity (that is, the
lowest mV value) in the presence of atrial flutter or fibrillation can result in fatal arrhythmias.
Electrostatic discharge (ESD) – The pacing lead(s) provides a low-impedance pathway
to the heart. Therefore, it is recommended that attending health care professionals
discharge any static electricity by touching a large metal or conductive, grounded surface
before touching the patient, the cable, the leads, or the temporary pacemaker. Also,
neutralize any static electricity from the patient by touching the patient away from (i.e., distal
to) the leads.
Retrograde conduction – If retrograde P-waves are being sensed outside the
rate-dependent, automatic Post-Ventricular-Atrial-Refractory Period (PVARP) setting,
manually increase the PVARP until the retrograde waves fall inside the PVARP. Failure to
follow this procedure may lead to a pacemaker-mediated tachycardia (PMT).
Termination of pacing – Abrupt termination of pacing stimuli may result in intervals of
asystole before an intrinsic rhythm is re-established. Before terminating pacing, set the
temporary pacemaker to a demand mode; then gradually reduce the pacing rate below the
patient’s intrinsic rate.
Pause key – Use the Pause key with care since the patient receives no pacing support (for
a maximum of 10 s at a time) when the Pause key is pressed and held.
A-V Interval – Programming long A-V intervals may result in pacing the ventricle during the
vulnerable period of ventricular repolarization, thus precipitating ventricular arrhythmias in
unstable patients.
DOO/Emergency key – Use the DOO/Emergency key only when high-output
asynchronous pacing (DOO) is needed. When the DOO/Emergency key is pressed, the
emergency pacing mode is entered and remains in effect until the emergency pacing mode
is deactivated. Press the Enter key to deactivate emergency pacing mode.
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3.1 Controls
The dials and keys used to control the functions and parameter settings of the temporary
pacemaker are described in this chapter.
Note: All adjustments to the RATE, A (Atrial) OUTPUT, and V (Ventricular) OUTPUT dials
take effect within the next two pacing cycles.
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A V
PACE SENSE PACE SENSE
RATE
30 200 ppm
A OUTPUT
0 20 mA
V OUTPUT
0 25 mA
The lower screen controls are used to select pacing modes, to adjust pacing parameter
values, to deliver RAP pacing therapy, to resume synchronous pacing from asynchronous
pacing, and to pause pacing therapy (see Figure 2). The lower screen displays the Mode
Selection menu, pacing parameters, the RAP screens, and warnings and information
messages.
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Mode Selection
Back
Note: Upper and lower screens values contained in this manual are presented for reference
only. Actual values may vary, depending on pacing mode, outputs, and parameter value
selections.
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Caution: Use the Pause key with care. The patient receives no pacing support when the
Pause key is pressed and held (for a maximum of 10 s at a time).
3.2 Indicators
The upper screen displays indicators for the pacing and sensing status bar, current pacing
mode, battery power, and lock status. See Figure 9.
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Figure 9. Indicators
A V
PACE SENSE PACE SENSE
RATE
30 200 ppm
A OUTPUT
0 20 mA
V OUTPUT
0 25 mA
A V
PACE SENSE PACE SENSE
A V
PACE SENSE PACE SENSE
RATE
30 200 ppm
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The A and V chamber indicators, if present, indicate that the selected pacing mode enables
the A and/or V chambers for pacing and sensing. However, pacing and sensing only occurs
when the PACE and SENSE indicators are present.
The PACE and SENSE indicators, if present, indicate that the selected pacing mode
enables pacing and sensing in the A and/or V chambers.
Note: While the PACE and SENSE indicators identify which chambers the temporary
pacemaker is set to pace and/or sense, they do not indicate actual temporary pacemaker
interaction with the heart.
The PACE and SENSE LEDs next to the A and V chamber indicators indicate delivery of a
pacing pulse or a sensed event. The LEDs flash when the following pacing or sensing events
occur, as follows:
● The green LED to the left of the A chamber indicator flashes each time the temporary
pacemaker delivers a pacing pulse on the atrial channel.
● The green LED to the left of the V chamber indicator flashes each time the temporary
pacemaker delivers a pacing pulse on the ventricular channel.
Note: The green LED flashes indicate delivery of a pacing pulse, but they are not
confirmation that the pacing pulse has initiated cardiac stimulation.
● The blue LED to the right of the A chamber indicator illuminates when events are sensed
on the atrial channel. The A SENSE LED flashes when the temporary pacemaker
detects events inside and outside the Atrial Refractory Period (ARP).
● The blue LED to the right of the V chamber indicator illuminates when events are sensed
on the ventricular channel. The V SENSE LED flashes only when the temporary
pacemaker detects an event outside a ventricular blanking period.
Note: The blue LEDs indicate a sensed event by the temporary pacemaker, but they are
not confirmation of a cardiac contraction.
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Note: When the low battery indicator appears, the temporary pacemaker maintains pacing
at the current settings, for a minimum of 24 hours, if the settings were at nominal values (see
Section 7.1).
If the batteries are removed, no bars are visible in the battery status indicator. The upper
screen is visible, but the lower screen is not displayed. The temporary pacemaker continues
to pace and sense until insufficient power is available (see Section 4.3).
After the batteries are depleted, the temporary pacemaker shuts down.
Note: The DOO/Emergency key remains active when the temporary pacemaker is locked.
If the DOO/Emergency key is pressed when the temporary pacemaker is locked, the
temporary pacemaker initiates high-output, dual-chamber asynchronous pacing (DOO for
emergency).
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3.3.1 RATE
The RATE ranges from 30 to 200 ppm (see Figure 11). Turn the RATE dial clockwise to
increase RATE and counterclockwise to decrease RATE.
When the temporary pacemaker is turned on, the RATE is set to 80 ppm (nominal). See
Section 7.1 for the RATE increments.
Figure 11. RATE scale, value, and dial
A V
PACE SENSE PACE SENSE
RATE
30 200 ppm
Note: The rate-dependent parameters UPPER RATE, PVARP, and A-V INTERVAL are
automatically adjusted each time RATE is adjusted unless they are manually set (see
Section 5.3.2).
0 20 mA
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Note: When A OUTPUT is turned off manually, both the atrial output and the atrial sensitivity
are turned off and there is no atrial pacing or sensing. If A OUTPUT is turned back on
manually before the temporary pacemaker locks (see Section 5.1.2), atrial sensitivity is set
to the previously selected value. If the temporary pacemaker locks after turning off
A OUTPUT, atrial sensitivity is set to the nominal value of 0.5 mV when A OUTPUT is turned
back on.
0 25 mA
Note: When V OUTPUT is turned off manually, both the ventricular output and the
ventricular sensitivity are turned off and there is no ventricular pacing or sensing. If
V OUTPUT is turned back on manually before the temporary pacemaker locks (see
Section 5.1.2), ventricular sensitivity is set to the previously selected value. If the temporary
pacemaker locks after turning off V OUTPUT, ventricular sensitivity is set to the nominal
value of 2.0 mV when V OUTPUT is turned back on.
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When the Mode Selection menu is displayed, use the Up or Down arrow keys to highlight a
pacing mode with the selection indicator (see Figure 14). Press the Enter key to select the
pacing mode.
Figure 14. Mode Selection menu
Access the Mode Selection menu using one of the following methods:
● Turn on the temporary pacemaker using the On/Off key
● Select Mode Selection from a Pacing Parameters menu (see Figure 15)
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See Section 5.1.6, Section 5.3, and Section 5.5 for additional information about pacing
parameters, RAP, and the Mode Selection menu.
Note: The Pacing Parameters menu only provides access to the parameters for the selected
pacing mode. Not every pacing parameter is accessible for each pacing mode.
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Note: For information about cleaning and sterilizing the reusable cables, refer to the
applicable technical manual.
Caution: Clean and disinfect the temporary pacemaker before each use for a new patient.
Clean and sterilize the reusable cables before each use for a new patient.
Caution: Before each use, evaluate the temporary pacemaker for damage and observable
defects. Do not use the temporary pacemaker if the case is cracked, the controls are not
functioning, the displays are not working, or if the controls, displays, or connectors are
broken. If the temporary pacemaker has any observable defects, contact Medtronic at the
telephone number on the back cover of this manual for service.
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Battery life – The battery life is 7 days minimum with continuous operation for an alkaline
battery when the RATE is set at 80 ppm and all other parameters are at nominal values (see
Section 7.1).
Note: After 6 days, or when the battery status displays 1 bar, the low battery status indicator
flashes. When the low battery indicator flashes, the temporary pacemaker has 24 hours of
battery life remaining.
Battery drawer latch release button – The battery drawer latch release button at the
bottom of the temporary pacemaker opens the battery drawer when it is pressed.
Continued operation after the batteries are removed – If the batteries are removed, the
temporary pacemaker continues to operate for 30 s, minimum (see Section 7.1), under the
following conditions: RATE of 80 ppm or less, A OUTPUT and V OUTPUT of 10 mA or less,
backlight off, and lower screen blank.
Note: The temporary pacemaker may shut down immediately, depending upon the battery
level, if the batteries are removed while it is turned on.
A V
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1 IV pole hanger
Note: If the Medtronic Model 53921 IV pole hanger requires replacement, contact your
Medtronic sales or service representative.
4.3 Batteries
Warning: Properly ground all line-powered equipment used on the patient or in the vicinity
of the patient (see Section 2.1).
Caution: Monitor the patient’s ECG and blood pressure and keep defibrillation equipment
on standby, immediately available for emergency use during pacing lead insertion and
pacemaker connection.
The temporary pacemaker uses two LR6–sized (AA–sized) alkaline batteries for operation
(for example, Duracell MN1500 or Eveready E91 batteries).
Cautions:
● Only install the recommended batteries in the temporary pacemaker. Batteries with
different physical dimensions, non-alkaline (e.g., lithium or rechargeable) or batteries
with contamination on the battery terminals, may result in erratic operation of the
temporary pacemaker, no pacing output, or damage to the temporary pacemaker,
specifically to the battery compartment.
● Inspect battery terminals for contamination. Using batteries with contaminated
terminals can result in the temporary pacemaker turning off, decreased battery life, or
corrosion to the battery compartment.
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When installing, replacing, or checking the battery status, verify the following items:
● Check the battery status regularly while the temporary pacemaker is in use.
● Verify that the low battery indicator is not flashing.
Remove the batteries when the temporary pacemaker is not in use.
Note: When the low battery indicator flashes, the temporary pacemaker maintains pacing at
the current settings for a minimum of 24 hours, if the settings were at nominal values (see
Section 7.1).
Caution: Medtronic does not recommend replacing the batteries while the temporary
pacemaker is turned on or actively pacing the patient. However, if during an emergency
situation the batteries must be replaced while the temporary pacemaker is in use, ensure
that the temporary pacemaker is locked before replacing the batteries. Pacing is maintained
at the current settings for 30 s, minimum, if the settings are at nominal values (see
Section 7.1).
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Caution: Ensure that the new, fresh batteries are installed with the correct battery
polarity by verifying that the batteries align with the polarity markings on the inside of the
battery drawer. The temporary pacemaker requires proper battery polarity for
operation. After installing the batteries, ensure that the battery status indicator displays
full battery power and that the low battery indicator is not flashing. The temporary
pacemaker may temporarily continue to pace and sense with weak, dead, or incorrectly
installed batteries.
4. Close the battery drawer firmly until the battery drawer is fully latched.
Note: Failure to close the battery drawer completely can result in the battery drawer
opening and the temporary pacemaker shutting down.
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Warnings:
● Before connecting the cables to the temporary pacemaker, verify that it is turned off.
● Connect the cables to the temporary pacemaker before connecting the leads to the
cables.
● To prevent pacing into the vulnerable period of the T-wave, turn on the temporary
pacemaker and turn down A OUTPUT and V OUTPUT to the minimum amplitude before
connecting the temporary pacemaker to the patient’s lead system. Determine sensing
thresholds before turning up A OUTPUT and V OUTPUT to threshold levels.
Cautions:
● When mechanical support is necessary, hang the temporary pacemaker by the IV pole
hanger from an IV pole. Do not hang the temporary pacemaker to an IV pole by the
cables.
● Avoid contaminating areas that are difficult to clean on the temporary pacemaker. Keep
hands and gloves free of blood and body fluids when connecting or disconnecting the
patient cables, surgical cables, and/or pacing leads to the temporary pacemaker.
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Refer to the applicable patient cable or surgical cable technical manual for more information.
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Refer to the applicable patient cable or surgical cable technical manual for more information.
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Figure 22. Connecting the pacing lead system to the patient cable receptacles
Refer to the applicable patient cable technical manual for more information.
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Refer to the applicable patient cable technical manual for more information.
Caution: Tampering with programmed parameters may have direct and serious patient
health effects.
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Warning: To prevent pacing into the vulnerable period of the T-wave, turn on the temporary
pacemaker and turn down A OUTPUT and V OUTPUT to the minimum amplitude before
connecting the temporary pacemaker to the patient’s lead system. Determine sensing
thresholds before turning up A OUTPUT and V OUTPUT to threshold levels.
To turn off the temporary pacemaker, do the following:
1. Unlock the temporary pacemaker if it is locked (see Section 5.1.2).
2. Press the On/Off key once. A message is displayed in the lower screen to confirm
temporary pacemaker shutdown (see Figure 23).
3. Press the Enter key once within 30 s to confirm temporary pacemaker shutdown.
Note: If the Enter key is not pressed, the temporary pacemaker remains on and continues
to pace at the currently selected values.
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Notes:
● See Section 7.1 for nominal values when the temporary pacemaker is turned on.
● If the temporary pacemaker fails the self-test, it remains on but does not pace.
● If the batteries are nearing depletion, a red backlight begins flashing behind the battery
status indicator, indicating that the batteries have approximately 24 hours or less of
battery life. If the batteries are depleted, the LEDs may flash momentarily (see
Section 3.2.1) when the On/Off key is pressed, but the temporary pacemaker does not
operate.
5.1.2 Lock/Unlock
The Lock/Unlock key locks the temporary pacemaker to prevent inadvertent adjustment of
the parameters, or unlocks the temporary pacemaker when it is locked (see Section 3.1.7).
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● The lower screen does not appear. The Mode Selection options and pacing parameters
cannot be adjusted.
● The Pause key is locked.
Notes:
● If any parameter dials are adjusted or any keys are pressed while the temporary
pacemaker is locked (other than the DOO/Emergency key), the Lock indicator flashes,
and the lower screen displays the Locked message for approximately 30 s (see
Figure 24).
● If the DOO/Emergency key is pressed while the temporary pacemaker is locked, the
temporary pacemaker begins asynchronous pacing (see Section 5.1.9).
Figure 24. Locked message
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Caution: Use the Pause key with care. The patient receives no pacing support (for a
maximum of 10 s at a time) when the Pause key is pressed and held.
When the Pause key is pressed and held, the message shown in Figure 25 appears in the
lower screen.
Figure 25. Caution: Pacing is suspended message
When the Pause key is released or pause times out at 10 s, the temporary pacemaker
resumes pacing at the programmed parameters.
Note: To pause again (up to 10 s), release the Pause key, and then press and hold the Pause
key again (this is a safety feature).
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RATE
30 200 ppm
A OUTPUT
0 20 mA
V OUTPUT
0 25 mA
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The Pacing Mode indicator in the upper screen displays the selected mode. The new mode
is activated within the next two cardiac cycles.
If no timing violations occur, the new pacing mode retains the current setting of all applicable
parameters of the previous pacing mode. If timing violations occur, the rate-dependent
parameters are set to automatic values (see Section 5.4).
Caution: Do not configure the temporary pacemaker in dual chamber mode unless both
channels are connected to the heart. If the temporary pacemaker is configured in a dual
chamber mode and one of the channels is not connected, the open channel could pick up
unintended noise. The noise can be interpreted as a sensed event and can lead to events
such as, but not limited to, asynchronous ventricular pacing, pacemaker mediated
tachycardia, or ventricular tachycardia.
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Note: Manually set pacing parameter values are not retained when the temporary
pacemaker is turned off and then turned back on.
Note: Determine sensitivity and stimulation thresholds (see Section 5.2); otherwise
asynchronous pacing, and/or loss of heart capture may occur.
Select one of the pacing modes in Table 1 from the Mode Selection menu to initiate demand
pacing.
Table 1. Pacing modes with demand pacing
Synchronous (demand) pac-
ing type Pacing mode Result
Dual chamber DDD, DDI Pacing and sensing occurs in
both chambers.
Atrium AAI Pacing and sensing occur only
in the atrium. No pacing or
sensing occurs in the ventricle.
Ventricle VVI Pacing and sensing occur only
in the ventricle. No pacing or
sensing occurs in the atrium.
Caution: Because it may compete with the intrinsic activity of the heart, asynchronous
pacing may result in tachyarrhythmia. Use caution when setting the device to asynchronous
modes.
Initiate asynchronous pacing by pressing the DOO/Emergency key or selecting an
asynchronous pacing mode from the Mode Selection menu.
Select one of the pacing modes in Table 2 from the Mode Selection menu to initiate
asynchronous pacing.
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Note: Determine the patient’s stimulation threshold; otherwise loss of heart capture may
occur (see Section 5.2.3.1).
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Adjust the RATE, A OUTPUT, and V OUTPUT by turning the 3 upper dials clockwise or
counterclockwise.
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5.2 Thresholds
Threshold values are needed to determine the appropriate settings for output and
sensitivity. Procedures for finding atrial and ventricular sensing and stimulation thresholds
are described in this section.
Note: To reduce the risk of competitive pacing, determine the sensing thresholds first, if the
patient’s intrinsic rhythm is adequate.
200 ms
The ECG in Figure 30 shows one example of undersensing. The temporary pacemaker does
not detect intrinsic activity and thus paces on or between beats.
Figure 30. Atrial undersensing
200 ms
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A. Sense EGM
AS AP AS
Marker Channel
VS VS VP
V. Sense EGM
Sensing threshold
1 After an atrial sensed event, the temporary pacemaker is temporarily less sensitive to atrial
events.
2 After a ventricular sensed event, the temporary pacemaker is temporarily less sensitive to
ventricular events.
3 After an atrial paced event, the temporary pacemaker is temporarily less sensitive to ventricular
events, but the sensitivity to atrial events remains the same.
4 After a ventricular paced event, the temporary pacemaker is temporarily less sensitive to atrial
events.
5 After the post-pace blanking period, the device is temporarily less sensitive to ventricular events.
6 After the post-pace blanking period, the temporary pacemaker is temporarily less sensitive to
atrial events.
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Caution: Avoid selecting a pacing mode that requires sensing if adequate sensing margins
cannot be established. A 2:1 safety margin cannot always be achieved due to a low sensing
amplitude and/or a high pacing amplitude. If a 2:1 safety margin cannot be achieved,
increase monitoring of the patient to verify that the expected therapy is being delivered.
2. Set RATE to at least 10 ppm under the patient’s intrinsic rate. If necessary, continue to
reduce the RATE until the temporary pacemaker is not pacing the patient (see
Figure 32).
3. Adjust the atrial or ventricular output to prevent the risk of competitive pacing (see
Figure 32), as follows:
● Atrial: Set A OUTPUT to 0.1 mA.
● Ventricular: Set V OUTPUT to 0.1 mA.
Figure 32. Decrease RATE, A OUTPUT, and V OUTPUT
A V
PACE SENSE PACE SENSE
RATE
30 200 ppm
A OUTPUT
0 20 mA
V OUTPUT
0 25 mA
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8. Increase Sensitivity: Slowly turn the Menu Parameter dial clockwise (decrease mV
value) until the SENSE indicator starts flashing (see Figure 34). The following occurs:
● The PACE indicator stops flashing.
● This value is the sensing threshold.
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9. Set Sensitivity to half (or less) the threshold value. This setting provides at least a 2:1
safety margin.
10. Restore RATE, A OUTPUT, or V OUTPUT to previous values.
Note: Determine the atrial or ventricular stimulation thresholds after determining sensing
thresholds.
200 ms
When capture is lost, the ECG shows no heart response after the pulse, as in the example
shown in Figure 36.
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200 ms
Caution: A 2:1 safety margin cannot always be achieved due to a very high pacing
amplitude. If a 2:1 safety margin cannot be achieved, increase monitoring of the patient to
verify that the expected therapy is being delivered.
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RATE
30 200 ppm
A OUTPUT
0 20 mA
V OUTPUT
0 25 mA
4. Increase OUTPUT: Slowly turn the output dial clockwise until ECG shows consistent
capture (see Figure 38). The following occurs:
● The PACE indicator flashes continuously; the SENSE indicator stops flashing.
● This value is the stimulation threshold.
Figure 38. Increase OUTPUT
A V
PACE SENSE PACE SENSE
RATE
30 200 ppm
A OUTPUT
0 20 mA
V OUTPUT
0 25 mA
5. Set OUTPUT to a value at least 2 to 3 times greater than the stimulation threshold value.
This setting provides at least a 2:1 safety margin.
6. Restore RATE to the previous value.
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The Pacing Parameters menu displays the parameters appropriate for the current pacing
mode and allows you to change their values. Depending on the pacing mode, a subset of
pacing parameters is displayed. Parameters that do not apply to the current chambers being
paced and sensed are not displayed. Parameters that did not apply in the previous mode are
set to nominal values in the new mode (see Section 5.6.7).
The parameters displayed in a pacing mode are based on the currently programmed pacing
mode and rate.
To adjust pacing and sensing parameters, perform the following steps:
1. Select a pacing mode from the Mode Selection menu by pressing the Up or Down
Arrow key.
2. Press the Enter key. The pacing parameters for the selected pacing mode are
displayed.
3. Press the Up or Down Arrow key to scroll through and select a pacing or sensing
parameter.
4. Turn the Menu Parameter dial clockwise or counterclockwise to adjust the value of the
selected parameter.
Note: Any value changes to the pacing parameters are not retained when the temporary
pacemaker is turned off. All pacing parameters are set to default values when the temporary
pacemaker is turned on.
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5.3.1 Sensitivity
5.3.1.1 A (Atrial) Sensitivity
Unless manually adjusted, the atrial sensitivity (A Sensitivity) is set to the nominal value of
0.5 mV. A Sensitivity can be adjusted between 0.4 and 10 mV by turning the Menu
Parameter dial, as follows:
● To increase A Sensitivity, turn the dial clockwise (the mV value decreases).
● To decrease A Sensitivity, turn the dial counterclockwise (the mV value increases).
The change takes effect within the next two pacing cycles.
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To turn off A Sensitivity to allow the temporary pacemaker to pace asynchronously in the
atrium, turn the Menu Parameter dial counterclockwise until the term ASYNC appears (see
Figure 40).
The pacing and sensing status bar indicators at the top of the upper screen reflect this
change. The SENSE indicator under A SENSE LED is not displayed, and the A SENSE LED
no longer flashes.
A Sensitivity is automatically set to ASYNC when the following occur:
● The DOO/Emergency key is pressed.
● RAP is delivered.
● DOO pacing mode or AOO pacing mode is selected from the Mode Selection menu.
Note: A Sensitivity is inaccessible when A OUTPUT is turned off or in VVI or VOO pacing
modes.
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The change takes effect within the next two pacing cycles.
To turn off V Sensitivity to allow the temporary pacemaker to pace asynchronously in the
ventricle, turn the Menu Parameter dial counterclockwise until the term ASYNC appears
(see Figure 41).
The pacing and sensing status bar indicators at the top of the upper screen reflect the
change. The SENSE indicator under the V SENSE LED is not displayed, and the V SENSE
LED no longer flashes.
V Sensitivity is automatically set to ASYNC when the following occur:
● The DOO/Emergency key is pressed.
● DOO pacing mode or VOO pacing mode is selected from the Mode Selection menu.
Note: V Sensitivity is inaccessible when V OUTPUT is turned off or in AAI or AOO pacing
modes.
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When manually set, the rate-dependent parameters do not change with adjustments to the
RATE. However, an increase in the RATE can cause a timing violation with the Upper Rate.
Also, a decrease of the RATE can cause a timing violation with the A-V Interval or PVARP.
If adjustments to RATE cause a timing violation, a warning message appears on the lower
screen. The RATE cannot be increased until Upper Rate is increased or A-V Interval
and/or PVARP are adjusted (see Section 5.4).
Notes:
● The A-V Interval after an atrial sensed event [that is, sensed atrioventricular interval
(SAV)] is not programmable. The SAV is automatically set to a value 30 ms less than the
A-V Interval in DDD pacing mode. In DDI pacing mode, SAV = PAV.
● Unless manually adjusted, A-V Interval is set to a value determined by the RATE
setting. It can never be shorter than 50 ms or longer than 250 ms.
Warning: If A-V Interval is set shorter than 50 ms, ventricular events may not be sensed
during that interval, due to ventricular blanking after an atrial event.
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Note: The Upper Rate parameter is only adjustable in DDD pacing mode.
Unless manually adjusted, this parameter is limited to the range of 110 to 230 ppm. When
selected on the Pacing Parameters menu, however, the Upper Rate can be adjusted to
values from 80 to 230 ppm. See Section 7.1.
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Note: If PVARP is set to the minimum value of 150 ms, atrial events may not be sensed due
to the tolerance allowed for blanking after a paced event (see Section 7.1).
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5.3.3 A. Tracking
A. Tracking (atrial tracking) is only accessible or applicable when the temporary pacemaker
is set to sense and pace in both chambers. When A. Tracking is turned On, the temporary
pacemaker paces the ventricle in synchrony with intrinsic atrial depolarizations.
When A. Tracking is turned on (DDD pacing mode), each sensed event on the atrial lead
not only inhibits the scheduled atrial pacing pulse, but also triggers an A-V Interval.
Warning: If a patient is prone to atrial arrhythmias, atrial tracking could lead to the
development of ventricular arrhythmias (see Section 1.7).
When A. Tracking is off (DDI pacing mode), an atrial sense will inhibit an atrial pace, but it
does not trigger an A-V Interval (see Figure 45). The ventricle is paced at the selected
RATE.
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Note: A. Tracking can be set to Off only from DDD pacing mode and set to On only from DDI
pacing mode.
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5.3.4 Settings
The Settings parameter sets the A-V Interval, Upper Rate, and PVARP to automatic,
rate-dependent settings (see Section 7.1).
If A-V Interval, Upper Rate, or PVARP pacing parameters are manually adjusted (in a dual
chamber pacing mode), the Pacing Parameters menu displays the following changes:
● Manual* appears to the right of Settings (see Figure 46).
● An asterisk (*) appears next to the value of each setting that is manually adjusted.
Figure 46. Automatic/Manual Settings field
To change A-V Interval, Upper Rate, and PVARP back to automatic, rate-dependent
settings, perform these steps:
1. Navigate to the Pacing Parameters menu.
2. Select Settings.
3. Turn the Menu Parameter dial either clockwise or counterclockwise until Automatic
replaces Manual.
4. Use the Menu Parameter dial to alternate between Automatic and Manual parameter
settings, as long as Settings remains selected.
Previous Manual settings are lost when Automatic is selected.
Note: The rate-dependent parameter values are immediately updated on the screen and
take effect at the next appropriate event when switching Settings from Automatic to
Manual, or Manual to Automatic.
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If the temporary pacemaker reaches a block point, press the Enter key and adjust one of the
following pacing parameters:
● RATE
● A-V Interval
● Upper Rate
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● PVARP
● Select Settings and adjust the value to Automatic (see Section 5.3.4).
If no adjustments are made, the message disappears after approximately 30 s, and the
temporary pacemaker continues to operate at the value selected prior to reaching the block
point.
Notes:
● DDD pacing mode: SAV Interval = AV Interval - 30 ms
● DDI pacing mode: SAV = PAV
During manual adjustment of RATE or the rate-dependent parameters, the temporary
pacemaker limits adjustment at the block point and displays the warning message shown in
Figure 47.
Note: This limit only occurs in DOO pacing mode. In DDD and DDI pacing modes, the RATE
versus A-V Interval and PVARP block point maintains a 180 ms V-A interval (where V-A
interval = 150 ms minimum PVARP + 30 ms).
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Caution: RAP is for atrial use only. Before enabling RAP, be sure that the atrial leads are
connected to the atrium, not the ventricle.
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When the Enter key is pressed and held, the temporary pacemaker waits a maximum of two
pacing cycles, and then begins pacing asynchronously in the atrium (AOO pacing mode) at
the selected RAP rate. See Figure 49.
Figure 49. Delivering rapid atrial pacing
Note: The temporary pacemaker does not deliver RAP until the Enter key is pressed and
held. RATE, A OUTPUT, V OUTPUT remain at their selected values for the current pacing
mode until the Enter key is pressed and held.
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3. Verify that the leads are in contact with the atrium and are connected to the atrial
channel of the temporary pacemaker through a patient or surgical cable.
4. Press the Enter key to open the RAP screen.
The RAP screen displays the RAP rate (initially the rate of 250 ppm). Pacing continues
at currently displayed settings.
5. Adjust RAP rate as needed. Turn the Menu Parameter dial clockwise to increase rate,
or counterclockwise to decrease rate.
Note: The range for RAP is 80 ppm to 800 ppm.
To exit the RAP screen, use the Up or Down Arrow key to highlight Back, and then press the
Enter key.
During the delivery of RAP, the following value settings occur:
● A OUTPUT does not lock and may be adjusted during RAP delivery.
● V OUTPUT is off and not accessible during RAP delivery. V OUTPUT returns to its
previous value when the Enter key is released.
● There is no ventricular support during RAP.
● If the Enter key is pressed while A OUTPUT is turned off, RAP is delivered at 10 mA.
A OUTPUT returns to off as soon as the Enter key is released, even if A OUTPUT is
adjusted during RAP delivery.
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Note: When resuming operation in a demand mode, the temporary pacemaker first
searches for cardiac activity (during the first pacing cycle), and then begins sensing and
pacing in both chambers (DDD pacing mode).
Caution: If the temporary pacemaker continues to deliver RAP after the Enter key is
released, press the On/Off key or the DOO/Emergency key to stop RAP. If RAP continues to
be delivered, remove the batteries from the temporary pacemaker. Return the temporary
pacemaker for service.
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The temporary pacemaker has an Atrial Refractory Period (ARP), but does not have a
Ventricular Refractory Period (VRP). The initiation of these two types of pacing refractory
periods are described below:
Atrial Refractory Period (ARP) – The temporary pacemaker has two types of atrial
refractory periods:
● ARP, which is initiated by an atrial sense or pace
● Post Ventricular Atrial Refractory Period (PVARP), which is initiated by a ventricular
sense or pace
Ventricular Refractory Period (VRP) – A VRP is initiated by a ventricular pace or sense.
The temporary pacemaker does not use a VRP.
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If a ventricular sensed event is detected outside the 30 ms blanking window, but within
110 ms after an atrial paced event, a ventricular safety pacing (VSP) pulse is delivered at
110 ms after the atrial pace if the A-V INTERVAL is greater than 110 ms. The ventricular
pacing pulse is delivered at the A-V INTERVAL if the A-V INTERVAL is less than 110 ms.
If the RATE is set to 86 ppm or higher, the values of 110 ms change to 70 ms (see
Section 7.1). The VPACE LED and the VSENSE LED flash within 15 ms of each other.
Note: Mode Switch is only available when the temporary pacemaker is operating in DDD
pacing mode.
Mode Switch operation starts when the temporary pacemaker detects the onset of an atrial
tachyarrhythmia episode. The detection of AT/AF onset is based on the timing of atrial
events within the ventricular intervals.
After the temporary pacemaker detects the onset of an atrial tachyarrhythmia, Mode Switch
temporarily changes the pacing mode from DDD to a non-atrial tracking DDI pacing mode.
The ventricular pacing rate gradually changes from the tracking rate to the base rate. This
prevents an abrupt drop in the ventricular rate.
When the atrial tachyarrhythmia ends and the atrial rate decreases below the programmed
Upper Rate, Mode Switch changes the pacing mode back to DDD pacing mode.
Figure 50. Temporary DDI pacing mode screen
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Note: Do not expose the temporary pacemaker to ethers, acetone, chlorinated solvents, or
disinfectants. These solvents may damage the case, labels, or metal components.
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Note: Understanding the warnings listed in this manual is necessary to perform safety and
technical checks successfully.
Caution: Do not open the external case of the temporary pacemaker. Opening the external
case of the temporary pacemaker voids the warranty.
Medtronic does not recommend field repair of the device. Contact your local Medtronic sales
or service representative for service or repair.
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6.3 Service
Medtronic employs highly trained representatives and engineers located throughout the
world to serve you and, upon request, to provide training to qualified hospital personnel in the
use of Medtronic products. Medtronic also maintains a professional staff to provide technical
consultation to product users. For medical consultation, Medtronic can often refer product
users to outside medical consultants with appropriate expertise. For more information,
contact your local Medtronic representative.
Should service or repair be necessary, contact your local Medtronic sales or service
representative.
A serial number identifying each individual temporary pacemaker is printed on the back
surface of the device. Reference this serial number in any correspondence regarding this
device.
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7 Specifications
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Table 6. Rate and interval conversion chart for RATE and RAP
Rate RAP
Rate Interval Rate Interval
30 ppm 2000 ms 80 ppm 750 ms
35 ppm 1714 ms 100 ppm 600 ms
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Table 6. Rate and interval conversion chart for RATE and RAP (continued)
Rate RAP
40 ppm 1500 ms 120 ppm 500 ms
45 ppm 1333 ms 140 ppm 429 ms
50 ppm 1200 ms 160 ppm 375 ms
52 ppm 1154 ms 180 ppm 333 ms
54 ppm 1111 ms 185 ppm 324 ms
56 ppm 1071 ms 190 ppm 316 ms
58 ppm 1034 ms 195 ppm 308 ms
60 ppm 1000 ms 200 ppm 300 ms
62 ppm 968 ms 205 ppm 293 ms
64 ppm 938 ms 210 ppm 286 ms
66 ppm 909 ms 215 ppm 279 ms
68 ppm 882 ms 220 ppm 273 ms
70 ppm 857 ms 225 ppm 267 ms
72 ppm 833 ms 230 ppm 261 ms
74 ppm 811 ms 235 ppm 255 ms
76 ppm 789 ms 240 ppm 250 ms
78 ppm 769 ms 245 ppm 245 ms
80 ppm 750 ms 250 ppm 240 ms
82 ppm 732 ms 260 ppm 231 ms
84 ppm 714 ms 270 ppm 222 ms
86 ppm 698 ms 280 ppm 214 ms
88 ppm 682 ms 290 ppm 207 ms
90 ppm 667 ms 300 ppm 200 ms
92 ppm 652 ms 310 ppm 194 ms
94 ppm 638 ms 320 ppm 188 ms
96 ppm 625 ms 330 ppm 182 ms
98 ppm 612 ms 340 ppm 176 ms
100 ppm 600 ms 350 ppm 171 ms
105 ppm 571 ms 360 ppm 167 ms
110 ppm 545 ms 380 ppm 158 ms
115 ppm 522 ms 400 ppm 150 ms
120 ppm 500 ms 420 ppm 143 ms
125 ppm 480 ms 440 ppm 136 ms
130 ppm 462 ms 460 ppm 130 ms
135 ppm 444 ms 480 ppm 125 ms
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Table 6. Rate and interval conversion chart for RATE and RAP (continued)
Rate RAP
140 ppm 429 ms 500 ppm 120 ms
145 ppm 414 ms 520 ppm 115 ms
150 ppm 400 ms 540 ppm 111 ms
155 ppm 387 ms 560 ppm 107 ms
160 ppm 375 ms 580 ppm 103 ms
165 ppm 364 ms 600 ppm 100 ms
170 ppm 353 ms 620 ppm 97 ms
176 ppm 341 ms 640 ppm 94 ms
182 ppm 330 ms 660 ppm 91 ms
188 ppm 319 ms 680 ppm 88 ms
194 ppm 309 ms 700 ppm 86 ms
200 ppm 300 ms 720 ppm 83 ms
740 ppm 81 ms
760 ppm 79 ms
780 ppm 77 ms
800 ppm 75 ms
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8 Special notice
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9 Troubleshooting
9.1 Troubleshooting
9.1.1 Self-test
When the temporary pacemaker is turned on, a startup message appears in the lower
screen. A self-test is executed while the temporary pacemaker is turning on. The self-test
includes a check of all keys and critical internal circuits. The PACE and SENSE LEDs
illuminate to indicate progress during the self-test.
Note: Pressing any key while the self-test is in process can cause the temporary pacemaker
to fail the self-test. The temporary pacemaker interprets the pressed key as being “stuck”
and, therefore, malfunctioning. If a key is pressed during the self-test, causing a self-test
failure, the lower screen displays an error message until the key is released.
The upper and lower screens initialize when the temporary pacemaker turns on. All
indicators display, including the low battery indicator, for 2 s. The low battery indicator
displaying during the upper screen initialization does not indicate that the batteries are low.
If the batteries are low, the low battery indicator remains visible during temporary pacemaker
operation.
After successful completion of the self-test, the temporary pacemaker first searches for
cardiac activity (during the first pacing cycle), and then begins sensing and pacing in both
chambers (DDD pacing mode).
If the temporary pacemaker fails the self-test, the PACE and SENSE LEDs remain on in a
pattern indicating the failed test, and no output pulses are issued. Failure codes may be
displayed on the lower screen. Follow the instructions that appear on the screen to restart
the temporary pacemaker, or to return the temporary pacemaker for service (contact your
Medtronic representative). When returning the temporary pacemaker, remove the batteries,
and return both the temporary pacemaker and the batteries.
200 ms
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200 ms
● Perform sensing threshold test for the affected chamber. Provide at least a 2:1 safety
margin.
Note: If the patient does not have adequate intrinsic rhythm, consult a physician before
the test.
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9.1.3 Oversensing
Figure 53. Atrial oversensing
200 ms
200 ms
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● If the source is muscle activity, EMI, T-wave, or far-field sensing. Decrease the
sensitivity for the affected chamber. Select A Sensitivity or V Sensitivity, and then
slowly turn the Menu Parameter dial counterclockwise (increase mV value).
Note: When adjusting sensitivity or output, verify the appropriate safety margin.
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200 ms
200 ms
Note: If the intrinsic event occurs just before pacing, see Section 9.1.2.
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Index
Numerics Atrial pacing
blanking specifications . . . . . . . . . . . . . . . . . 83
2:1 safety margin
contraindicated . . . . . . . . . . . . . . . . . . . . . 11
sensing threshold . . . . . . . . . . . . . . . . . . . . 54
mode transition . . . . . . . . . . . . . . . . . . . . . 77
stimulation threshold . . . . . . . . . . . . . . . . . . 57
output dial . . . . . . . . . . . . . . . . . . . . . . . . 23
A Atrial sensing
AAI contraindication . . . . . . . . . . . . . . . . . . . . . 11
Mode selection . . . . . . . . . . . . . . . . . . . . . 29 Automatic adjustment
AAI mode sensitivity threshold . . . . . . . . . . . . . . . . . . . 53
pacing setup table . . . . . . . . . . . . . . . . . . . 85 Automatic/Manual(*) . . . . . . . . . . . . . . . . . . . . . 68
A (atrial) OUTPUT A-V Interval . . . . . . . . . . . . . . . . . . . . . . . . . . . 63
during RAP . . . . . . . . . . . . . . . . . . . . . . . . 73 A-V Interval (PAV) . . . . . . . . . . . . . . . . . . . . . . 63
nominal value . . . . . . . . . . . . . . . . . . . . . . 83 timing violations vs. RATE, PVARP . . . . . . . . . 71
A (atrial) Sensitivity . . . . . . . . . . . . . . . . . . . . . . 60 A-V INTERVAL (PAV)
vs. A OUTPUT . . . . . . . . . . . . . . . . . . . . . . 61 nominal value . . . . . . . . . . . . . . . . . . . . . . 84
A (atrial) SENSITIVITY ranges, automatic and manual . . . . . . . . . . . . 82
nominal value . . . . . . . . . . . . . . . . . . . . . . 83 safety pacing . . . . . . . . . . . . . . . . . . . . . . . 76
range, increments . . . . . . . . . . . . . . . . . . . . 81
ablation
B
Basic operation . . . . . . . . . . . . . . . . . . . . . . . . 43
microwave . . . . . . . . . . . . . . . . . . . . . . . . 12
off . . . . . . . . . . . . . . . . . . . . . . . . . . . 43, 44
RF . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
on . . . . . . . . . . . . . . . . . . . . . . . . . . . 43, 44
Accessories
Batteries
temporary pacemaker . . . . . . . . . . . . . . . . . 10
installation . . . . . . . . . . . . . . . . . . . . . . . . 35
Adverse effects . . . . . . . . . . . . . . . . . . . . . . . . 19
polarity . . . . . . . . . . . . . . . . . . . . . . . . . . 35
Amplitude, inappropriate variance . . . . . . . . . . . . . 14
recommendations . . . . . . . . . . . . . . . . . . . . 35
AOO
recommended battery type . . . . . . . . . . . . . . 34
Mode selection . . . . . . . . . . . . . . . . . . . . . 29
replacement . . . . . . . . . . . . . . . . . . . . . . . 35
AOO mode
Battery
during RAP . . . . . . . . . . . . . . . . . . . . . . . . 72
drawer . . . . . . . . . . . . . . . . . . . . . . . . . . 32
pacing setup table . . . . . . . . . . . . . . . . . . . 85
drawer release button . . . . . . . . . . . . . . . . . 33
Arrow keys
life . . . . . . . . . . . . . . . . . . . . . . . . . . . 33, 84
selecting parameter values, modes . . . . . . . . . 24
precaution . . . . . . . . . . . . . . . . . . . . . . . . 14
ASYNC . . . . . . . . . . . . . . . . . . . . . . . . . . . 61, 62
type . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84
Asynchronous pacing . . . . . . . . . . . . . . . . . . . . 49
Battery indicator
caution . . . . . . . . . . . . . . . . . . . . . . . . . . 49
at power on . . . . . . . . . . . . . . . . . . . . . . . 44
contraindication . . . . . . . . . . . . . . . . . . . . . 11
Battery replacement
DOO/Emergency key . . . . . . . . . . . . . . . . . . 50
continued operation during . . . . . . . . . . . . 33, 84
to resume demand pacing . . . . . . . . . . . . . . . 50
Bipolar lead system . . . . . . . . . . . . . . . . . . . . . . . 7
transition rules . . . . . . . . . . . . . . . . . . . . . . 77
connecting to patient cable . . . . . . . . . . . . . . 41
A Tracking . . . . . . . . . . . . . . . . . . . . . . . . . . . 66
precautions . . . . . . . . . . . . . . . . . . . . . . . 15
A Tracking (atrial tracking) . . . . . . . . . . . . . . . . . . 66
Blanking . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83
Atrial
arrhythmias . . . . . . . . . . . . . . . . . . . . . . . 11 C
mapping . . . . . . . . . . . . . . . . . . . . . . . . . 16 Cable
connecting to temporary pacemaker . . . . . . . . . 38
connecting to temporary pacemaker, fig . . . . . . 39
Technical Manual 99
Medtronic 5392
Cables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 Disinfection
precautions . . . . . . . . . . . . . . . . . . . . . . . 15 temporary pacemaker . . . . . . . . . . . . . . . . . 78
sockets for . . . . . . . . . . . . . . . . . . . . . . . . 33 Disposable pouch . . . . . . . . . . . . . . . . . . . . . . . 18
Cable to lead system connections . . . . . . . . . . . . . 41 DOO/Emergency key
Capture, definition . . . . . . . . . . . . . . . . . . . . . . 56 function . . . . . . . . . . . . . . . . . . . . . . . . . . 22
Cardioversion . . . . . . . . . . . . . . . . . . . . . . . . . 12 if upper screen is locked . . . . . . . . . . . . . . . . 45
Cautery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 DOO mode
Cellular phones . . . . . . . . . . . . . . . . . . . . . . . . 13 Mode selection . . . . . . . . . . . . . . . . . . . . . 29
Chart pacing setup table . . . . . . . . . . . . . . . . . . . 85
mode vs parameter settings . . . . . . . . . . . . . . 85 Dual chamber pacing
Checks, safety and technical . . . . . . . . . . . . . . . . 78 definition . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Cleaning Dual chamber pacing mode
temporary pacemaker . . . . . . . . . . . . . . . . . 78 DDD, DDI, DOO, . . . . . . . . . . . . . . . . . . . . 29
Communication transmitters . . . . . . . . . . . . . . . . 13 Dual chamber pacing modes
Concomitant pacing precaution . . . . . . . . . . . . . . . . . . . . . . . . 16
contraindication . . . . . . . . . . . . . . . . . . . . . 11
Condition use
E
Electromagnetic interference (EMI) . . . . . . . . . . . . 13
prior to use . . . . . . . . . . . . . . . . . . . . . . . . 32
Electrostatic discharge (ESD) . . . . . . . . . . . . . . 17, 18
Conduction, retrograde . . . . . . . . . . . . . . . . . . . 17
Electrosurgical equipment . . . . . . . . . . . . . . . . . . 13
Connector block, temporary pacemaker . . . . . . . . . 33
Emergency pacing . . . . . . . . . . . . . . . . . . . . . . 50
Connector setup
initiating . . . . . . . . . . . . . . . . . . . . . . . . . . 50
cables and the temporary pacemaker . . . . . . . . 38
nominal values . . . . . . . . . . . . . . . . . . . . . 51
lead system to patient cables . . . . . . . . . . . . . 40
terminating . . . . . . . . . . . . . . . . . . . . . . . . 51
overview . . . . . . . . . . . . . . . . . . . . . . . . . 38
Enter key
precaution . . . . . . . . . . . . . . . . . . . . . . . . 14
Mode selection menu . . . . . . . . . . . . . . . . . 23
Contraindications . . . . . . . . . . . . . . . . . . . . . . . 10
Rapid atrial pacing . . . . . . . . . . . . . . . . . . . 72
Controls . . . . . . . . . . . . . . . . . . . . . . . . . . 20, 24
timing violations . . . . . . . . . . . . . . . . . . . . . 70
upper screen . . . . . . . . . . . . . . . . . . . . . . . 23
to resume demand pacing . . . . . . . . . . . . . . . 50
Conversion chart, rate and interval . . . . . . . . . . . . . 85
Environmental precautions . . . . . . . . . . . . . . . . . 18
D Equipment
DDD, DDI, DOO, AAI, AOO, VVI, VOO, OOO . . . . . . 47 diathermy . . . . . . . . . . . . . . . . . . . . . . . . . 13
DDD mode electrosurgical . . . . . . . . . . . . . . . . . . . . 12, 13
Mode selection . . . . . . . . . . . . . . . . . . . . . 29 line-powered . . . . . . . . . . . . . . . . . . . . . . . 12
pacing setup table . . . . . . . . . . . . . . . . . . . 85 magnetic resonance imaging (MRI) . . . . . . . . . 13
DDI medical telemetry . . . . . . . . . . . . . . . . . . . . 13
Mode selection . . . . . . . . . . . . . . . . . . . . . 29 Erratic output, sensing . . . . . . . . . . . . . . . . . . . . 14
DDI mode
pacing setup table . . . . . . . . . . . . . . . . . . . 85
F
Failures
Defibrillation . . . . . . . . . . . . . . . . . . . . . . . . . . 12
random . . . . . . . . . . . . . . . . . . . . . . . . . . 14
precaution . . . . . . . . . . . . . . . . . . . . . . . . 15
self-test . . . . . . . . . . . . . . . . . . . . . . . . . . 89
Demand pacing
Features
resume . . . . . . . . . . . . . . . . . . . . . . . . . . 51
automatic . . . . . . . . . . . . . . . . . . . . . . . . . 74
Demand (synchronous) pacing
physical . . . . . . . . . . . . . . . . . . . . . . . . . . 32
to resume from asynchronous . . . . . . . . . . . . 51
safety . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Description, general . . . . . . . . . . . . . . . . . . . . . . 7
Fluid incursion, precautions . . . . . . . . . . . . . . . . . 18
Device maintenance . . . . . . . . . . . . . . . . . . . . . 80
temporary pacemaker . . . . . . . . . . . . . . . . . 78 G
Dials . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 General description . . . . . . . . . . . . . . . . . . . . . . . 7
Diathermy equipment . . . . . . . . . . . . . . . . . . . . 13
Dimensions . . . . . . . . . . . . . . . . . . . . . . . . . . 84
H Lock feature . . . . . . . . . . . . . . . . . . . . . . . . . . 44
lock/unlock key . . . . . . . . . . . . . . . . . . . . . 23
High atrial rate response
Lower bar indicator
mode switch . . . . . . . . . . . . . . . . . . . . . . . 76
battery indicator . . . . . . . . . . . . . . . . . . . . . 27
HIGH OUTPUT
lock indicator . . . . . . . . . . . . . . . . . . . . . . . 27
adverse effect . . . . . . . . . . . . . . . . . . . . . . 19
Lower screen . . . . . . . . . . . . . . . . . . . . . . . . . 59
precaution . . . . . . . . . . . . . . . . . . . . . . . . 17
controls . . . . . . . . . . . . . . . . . . . . . . . . . . 58
High-rate pacing therapy
menus . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
contraindicated in ventricle . . . . . . . . . . . . . . 11
messages . . . . . . . . . . . . . . . . . . . 44, 70, 71
no ventricular back-up . . . . . . . . . . . . . . . . . 13
Mode selection menu . . . . . . . . . . . . . . . . . 29
precaution . . . . . . . . . . . . . . . . . . . . . . 13, 15
Pacing parameters menu . . . . . . . . . . . . . . . 30
Humidity . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
RAP . . . . . . . . . . . . . . . . . . . . . . . . . . 71, 73
I Rate-dependent parameters . . . . . . . . . . . 62, 68
Indications . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Indicators . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
M
Magnetic resonance imaging (MRI) . . . . . . . . . . . . 13
false signals . . . . . . . . . . . . . . . . . . . . . . . 14
Manual/Automatic . . . . . . . . . . . . . . . . . . . . . . . 68
lock . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44
Mapping, atrial . . . . . . . . . . . . . . . . . . . . . . . . . 16
pace and sense LEDs . . . . . . . . . . . . . . . . . 25
Medical telemetry equipment . . . . . . . . . . . . . . . . 13
Indifferent electrode . . . . . . . . . . . . . . . . . . . . . 42
Menu parameter dial . . . . . . . . . . . . . . . . . . . . . 24
Intended use . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Menus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58
IV pole hanger . . . . . . . . . . . . . . . . . . . . . . . . . 33
Messages
fig. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
2:1 block point . . . . . . . . . . . . . . . . . . . . . . 70
Physical features . . . . . . . . . . . . . . . . . . . . 34
locked message . . . . . . . . . . . . . . . . . . . . . 45
use of the IV pole hanger . . . . . . . . . . . . . . . 38
off . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44
J Upper Rate violation . . . . . . . . . . . . . . . . . . 71
Jumper cable . . . . . . . . . . . . . . . . . . . . . . . . . 42 microwave ablation . . . . . . . . . . . . . . . . . . . . . . 12
Modes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81
K nominal . . . . . . . . . . . . . . . . . . . . . . . . . . 83
Keys . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
Mode selection . . . . . . . . . . . . . . . . . . . . . . 47, 48
during lock . . . . . . . . . . . . . . . . . . . . . . . . 45
DDD, DDI, DOO, AAI, AOO, VVI, VOO, OOO . . . 47
L timing violations . . . . . . . . . . . . . . . . . . . 48, 69
Lead system transition rules . . . . . . . . . . . . . . . . . . . . . . 77
connection to cables . . . . . . . . . . . . . . . . . . 40 Mode switch
Lead systems DDD mode . . . . . . . . . . . . . . . . . . . . . . . . 76
adverse effects . . . . . . . . . . . . . . . . . . . . . 19 DDD pacing mode . . . . . . . . . . . . . . . . . . . 76
bipolar . . . . . . . . . . . . . . . . . . . . . . 7, 15, 41 detection rate . . . . . . . . . . . . . . . . . . . . . . 83
connecting to patient cables . . . . . . . . . . . . . 40 high atrial rate response . . . . . . . . . . . . . . . . 76
connecting to patient cables, fig. . . . . . . . . . . . 41 N
inappropriate connections . . . . . . . . . . . . . . . 19
Noise response . . . . . . . . . . . . . . . . . . . . . . . . 75
precautions . . . . . . . . . . . . . . . . . . . . . . . 15
asynchronous pacing . . . . . . . . . . . . . . . . . . 75
reposition . . . . . . . . . . . . . . . . . . . . . . . . . 19
Nominal values
unipolar . . . . . . . . . . . . . . . . . . . . . . . . 16, 41
DDD pacing mode . . . . . . . . . . . . . . . . . . . 83
warnings . . . . . . . . . . . . . . . . . . . . . . . . . 14
DOO for emergency . . . . . . . . . . . . . . . . . . 83
LED indicators
emergency pacing . . . . . . . . . . . . . . . . . . . 51
Sensitivity . . . . . . . . . . . . . . . . . . . . . . . . 62
No pacing mode
LEDs (light-emitting diodes)
OOO . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
during self-test . . . . . . . . . . . . . . . . . . . . . . 89
Line-powered equipment . . . . . . . . . . . . . . . . . . 12 O
Locked-up, self-test failure . . . . . . . . . . . . . . . . . 89 On/Off key . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
function . . . . . . . . . . . . . . . . . . . . . . . . . . 22
OOO Periods
Mode selection . . . . . . . . . . . . . . . . . . . . . 29 blanking . . . . . . . . . . . . . . . . . . . . . . . . . 74
Operation after battery removal . . . . . . . . . . . . . . . 84 refractory . . . . . . . . . . . . . . . . . . . . . . . 74, 75
OUTPUT . . . . . . . . . . . . . . . . . . . . . . . . . . 28, 29 Physical features . . . . . . . . . . . . . . . . . . . . . . . 32
high, adverse effect . . . . . . . . . . . . . . . . . . . 19 Pouch, disposable . . . . . . . . . . . . . . . . . . . . . . 18
inappropriate variance . . . . . . . . . . . . . . . . . 14 Power, loss of control . . . . . . . . . . . . . . . . . . . . 14
loss of control . . . . . . . . . . . . . . . . . . . . . . 14 precaution . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
nominal values . . . . . . . . . . . . . . . . . . . . . 83 Precautions
ranges and increments . . . . . . . . . . . . . . . . . 81 environmental . . . . . . . . . . . . . . . . . . . . . . 18
vs. Sensitivity . . . . . . . . . . . . . . . . . . . . 61, 62 Pulse width . . . . . . . . . . . . . . . . . . . . . . . . . . . 81
atrial . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
P inappropriate variance . . . . . . . . . . . . . . . . . 14
PACE LEDs
ventricular . . . . . . . . . . . . . . . . . . . . . . . . 29
during self-test . . . . . . . . . . . . . . . . . . . . . . 89
PVARP . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65
Pacing
manual adjustments . . . . . . . . . . . . . . . . . . 65
asynchronous, contraindication . . . . . . . . . . . 11
nominal value . . . . . . . . . . . . . . . . . . . . . . 84
atrial . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
range, increments . . . . . . . . . . . . . . . . . . . . 82
atrial, contraindication . . . . . . . . . . . . . . . . . 11
timing violations vs. RATE, A-V Interval . . . . . . . 71
high-rate therapy . . . . . . . . . . . . . . . . . . 11, 13
timing violations vs. SAV, Upper Rate . . . . . . . . 70
pacemaker mediated tachycardia . . . . . . . . . . 11
setup table . . . . . . . . . . . . . . . . . . . . . . . . 85 R
termination of . . . . . . . . . . . . . . . . . . . . . . 17 radio frequency ablation . . . . . . . . . . . . . . . . . . . 12
T-wave . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Random failures . . . . . . . . . . . . . . . . . . . . . . . . 14
Pacing mode . . . . . . . . . . . . . . . . . . . . . . . . . . 81 RAP . . . . . . . . . . . . . . . . . . . . . . . . . . 71, 72, 73
nominal . . . . . . . . . . . . . . . . . . . . . . . . . . 83 see also Rapid atrial pacing . . . . . . . . . . . . . . 71
selecting . . . . . . . . . . . . . . . . . . . . . . . . . 47 Rapid atrial pacing
selection . . . . . . . . . . . . . . . . . . . . . . . 47, 48 deliver . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
transitions . . . . . . . . . . . . . . . . . . . . . . . . 77 Rapid atrial pacing (RAP) . . . . . . . . . . . . . 71, 72, 73
Pacing mode at power-up A OUTPUT . . . . . . . . . . . . . . . . . . . . . . . . 73
DDD mode . . . . . . . . . . . . . . . . . . . . . . . . 22 caution . . . . . . . . . . . . . . . . . . . . . . . . 71, 72
Pacing mode selection . . . . . . . . . . . . . . . . . . . . 47 rate, nominal . . . . . . . . . . . . . . . . . . . . . . . 84
Pacing parameters menu . . . . . . . . . . . . . . . . . . 30 rate, range, increments . . . . . . . . . . . . . . . . 81
A-V Interval . . . . . . . . . . . . . . . . . . . . . . . . 63 to resume upper screen pacing . . . . . . . . . . . . 74
Parameters RATE
A Tracking . . . . . . . . . . . . . . . . . . . . . . . . 66 dial . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
A-V Interval . . . . . . . . . . . . . . . . . . . . . . . . 63 inappropriate variance . . . . . . . . . . . . . . . . . 14
locked parameters . . . . . . . . . . . . . . . . . . . 44 limit . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83
PVARP . . . . . . . . . . . . . . . . . . . . . . . . . . 65 loss of control . . . . . . . . . . . . . . . . . . . . . . 14
RATE . . . . . . . . . . . . . . . . . . . . . . . . . . . 47 nominal value . . . . . . . . . . . . . . . . . . . . 28, 83
SENSITIVITY . . . . . . . . . . . . . . . . . . . . . . 60 range, increments . . . . . . . . . . . . . . . . . . . . 81
Sensitivity . . . . . . . . . . . . . . . . . . . . . . 60, 61 timing violations . . . . . . . . . . . . . . . . . . . . . 70
Settings . . . . . . . . . . . . . . . . . . . . . . . . . . 68 timing violations vs. A-V Interval, PVARP . . . . . . 71
timing violations . . . . . . . . . . . . . . . . . . . . . 69 timing violations vs A-V Interval, PVARP . . . . . . 71
Upper Rate . . . . . . . . . . . . . . . . . . . . . . . . 62 timing violations vs.Upper Rate . . . . . . . . . . . . 71
Upper Rate . . . . . . . . . . . . . . . . . . . . . . . . 64 Rate-dependent parameters . . . . . . . . . . . . . . . . 62
Patient cable A-V Interval . . . . . . . . . . . . . . . . . . . . . . . . 63
connecting to lead system . . . . . . . . . . . . . . . 40 Lower screen . . . . . . . . . . . . . . . . . . . . . . 68
sockets for . . . . . . . . . . . . . . . . . . . . . . . . 33 manual settings . . . . . . . . . . . . . . . . . . . . . 62
Pause key mode transition . . . . . . . . . . . . . . . . . . . . . 77
precaution . . . . . . . . . . . . . . . . . . . . . . 17, 24 specifications . . . . . . . . . . . . . . . . . . . . . . 82
timing violations . . . . . . . . . . . . . . . . . . . . . 69
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